Kazuo Shiiki

Necrotizing fasciitis of the neck due to an odontogenic infection: A case report

Deep fascial space infections of the neck are most frequently odontogenic in origin. We describe a case of odontogenic infection of the mandible which extended to the lateral pharyngeal space and resulted in a severe life-threatening necrotizing fasciitis of the neck. A 69-year-old nondiabetic male complained of dysphagia and a severe toothache of the lower left molar and was transported to the emergency ward. A CT scan revealed swelling of the peritonsillar, lateral pharyngeal and masticator space with narrowing of the airway of the middle pharynx. The patient underwent a tracheotomy with surgical drainage. The strap muscles, including the fascia, of the neck were necrotic. He was treated with a combination of ampicillin and clindamycin-2-P. On the second postoperative day, the patients platelet count fell to 20,000/mm3. The patient was transfused with platelet concentrate, and given gamma globulin and gabexate mesilate, and his predisseminated intravascular coagulation (DIC) status improved. However, on the eight post operative day, progressive tissue necrosis of the face and neck was observed. Panipenem betamipron was started and continued for 20 days. A second extensive surgical debridement of the neck and face was carried out, and the patient ultimately recovered.Prevotella buccae, Streptococcus intermedius, Lactobacillus fermentum, L. casei, L. catenaforme, L. acidophilus, andBifidobacterium sp. were isolated from either the peritonsillar, submandibular, lateral pharyngeal or carotid space abscesses. We emphasize the importance of proper diagnosis, early surgical intervention and systemic antimicrobial chemotherapy to control this aggressive infectious disease.

Clinical Comparative Study of Quantitative Lysis Filtration and Lysis Centrifugation Blood Culture Techniques for Streptococcus Bacteremia

It has been suggested that transient bacteremia following oral procedures may cause infective endocarditis in susceptible patients and streptococci remain the most common pathogenic bacteria for infective endocarditis. Blood samples of 20 patients after tooth extraction were cultured by two different quantitative blood culture techniques; lysis filtration and lysis centrifugation (Isolater 10). Both techniques are performed by first lysing the blood cells, then followed by filtration or centrifugation. Isolated rates were compared by recovery of oral streptococci. The incidence of streptococcis bacteremia were 60% by lysis filtration and 5% by isolater 10. The concentration of oral streptococci in positive blood samples by lysis filtration ranged from 0.12 to 3.72 CFU/ml (mean, 0.62).Streptococcus constellatus andGemella morbillorum were isolated by both techniques in patient 1, the concentration was 3.72 CFU/ml by lysis filtration but only 0.2 CFU/ml by isolater 10.s. constellatus was the most common isolate. Also isolated wereS. intermedius, S. sanguis, S. mutans andG. morbillorum. Polymicrobial streptococcus bacteremia was found in 4 patients. A combination ofS. constellatus andG. morbillorum was isolated from three patients. In conclusion, lysis filtration was an excellent quantitative blood culture technique for the isolation of streptococci. Lysis filtration should provide a better comparison of the efficacy of different antibiotics used in the prevention of transient dental bacteremia.